Predictors of end-stage renal disease

Abstract

Chronic Kidney Disease (CKD) and End-Stage Renal Disease (ESRD) are serious threats to the public health in the United States. Medicare costs related to the treatment of these conditions are projected to reach $54 billion by 2020. Using data from the US Department of Veterans Affairs we conducted three retrospective cohort studies that examined impacts of different exposures on the incidence of CKD and ESRD. In study one, we estimated the effect of race on the rate of ESRD in a population with CKD after accounting for the competing risk of death. After accounting for the competing risks and after controlling for age, diabetes status, and the presence of hypertension, black veterans have a significantly higher rate of ESRD than do white veterans (HR: 2.32; 95% CI: 2.26, 2.39). In study two, we estimated the association between acute kidney injury (AKI) and CKD among patients with normal kidney function that were admitted to the hospital. Patients that experience AKI while hospitalized have 3.23 (95% CI: 1.46, 7.11) times the hazard of CKD than do patients that do not experience an event, after adjusting for age, CHF, diabetes, hypertension, baseline eGFR, and CAD. In study three, we compared the rate of CKD and ESRD in veterans taking an angiotensin receptor blocker (ARB) to the rate in veterans taking an angiotensin converting enzyme inhibitor. After adjusting for baseline glomerular filtration rates (eGFR), age, sex, race, hypertension and diabetes status, those veterans taking an ARB had 0.55 (95% CI: 0.53, 0.57) times the rate of kidney disease than did veterans taking an ACE. Decreased rates were seen in all dose groups and persisted in the high risk subgroups of the population. The results of the current studies highlight segments of the population that may benefit from prevention and intervention efforts and describe the comparative effectiveness of two potential pharmacologic interventions.